2013/2014 FAMILY REGISTRATION FORM New Families MUST complete both this form AND the camper enrolment form, making sure to complete ALL sections. Please mail holidays@sugarbay.co.za or call 032 485 3778 for help.
ALL RELEVANT DOCUMENTATION to be submitted before a booking can be completed.
YOU AND YOUR CHILD:
This form is being completed for the following children:
1.
2.
3.
4.
5.
The person who is completing this form is (name) Mother Father Uncle Aunt Sibling Grandmother Grandfather Family Friend Secretary
HOW I FIRST HEARD ABOUT SUGAR BAY: Former Camper School Tour School or Parent Presentation Magazine Television Other details:
FAMILY INFORMATION:
Please note that we need ALL THREE contact fields completed
Parent/Guardian (with whom the children live):
Relationship to child: Mother Father Uncle Aunt Sibling Grandmother Grandfather Family Friend Secretary First name:
Surname:
Tel (h):
Tel (w):
Tel (c):
Email:
Occupation:
Employer:
Postal address:
Residential address:
Fax:
2nd Parent/ guardian or primary emergency contact:
Alternative emergency contact:
MEDICAL COVER:
HOSPITAL COVER: Private Hospitals require copies of the following before any admission:
1. The medical aid card or travel insurance certificate for private hospital cover (front & back of card).
2. The child's ID or Birth Certificate
3. The (ID) Identity Document of the main or principle member of the insurance policy
We have to have all of these documents before accepting children into our care. Please fax through copies of all the above. We know it is a hassle but please understand that your child's safety might depend on it.
POLICY NAME: POLICY NUMBER: TYPE (hospital plan/ comprehensive/ travel insurance – give dates when covered): NAME OF PRINCIPAL MEMBER: ID no:
OUT OF HOSPITAL EXPENSES: Many medical aids only cover hospital admissions and/or very limited medical savings. We require an undertaking that the medical aid will cover all non-hospital expenses (eg doctors fees), failing which we need credit card details for emergencies. PLEASE TICK ONE OF THE FOLLOWING: I warrant that there will be sufficient funds in my fully comprehensive medical aid to cover all medical expenses such as doctor fees and prescribed medication that may be required for my children while visiting Sugar Bay, OR In the event that my medical aid or travel insurance does not cover certain medical expenses (e.g. private doctor fees or prescribed medication), I authorize Sugar Bay to debit my Visa/ Master/ Diners’ card (circle appropriate) with the relevant amounts. Credit card number Exp Date Cardholder’s name: CVC Number:
DETAILS OF CHILDREN:
First Child:
Full Name:
Preferred Name:
Male Female
Date of Birth:
School:
Dietry Riquirements:
Any allergies, disabilities or medical conditions:
Medical Aid dependant code:
Second Child:
More Children:
ACKNOWLEDGMENTS:
My children are all insured by a medical aid / travel insurance a copy of which I am sending with this form failing which I agree that my child can be treated at the nearest government hospital. I am responsible for all medical bills incurred for the treatment of my children while visiting Sugar Bay. In case of surgical emergency, I give permission to Sugar Bay to secure necessary medical treatment for my children. Sugar Bay has been given full disclosure of any pre-existing physical or mental ailments from which my children suffer. All efforts are made to have children participate in their activities of choice. However as new opportunities arise or practical considerations require the activities offered may vary. I acknowledge and understand the nature of Sugar Bay’s programs and give permission for my children to participate in all the activities. I accept that there are infrequent but inherent risks associated in such activities and accept these risks as part of my children’s participation. I understand that Sugar Bay will not be responsible for any loss or damage of personal articles while visiting Sugar Bay. Sugar Bay has the right to use any photographs of children for promotional purposes. All people attending Sugar Bay are required to comply with the code of conduct, explained in detail on arrival. The rules are for the health, safety and welfare of all the children and are strictly enforced. They include strict prohibitions against smoking, alcohol and drugs. Guests unable to abide by the rules are subject to dismissal without refund. Any dispute arising between the parties shall be settled in South Africa under South African law. This contract shall not be construed for or against a party because that party wrote it. These forms are complete to the best of my knowledge. I have read and agreed to all the terms and conditions contained on both forms. These acknowledgments apply to all future visits by any of my children to Sugar Bay. All information contained on this form will be kept on record however should any information change between now and when your child attends camp please contact us immediately.
Thank you for choosing Sugar Bay! Our bookings office will be in contact with you soon to follow up on your booking :